Snorting, of cocaine

Cocaine is a local vasoconstrictor, and snorting of cocaine intra-nasally reduces the amount of blood flow to the area, resulting in a reduced rate of drug absorption and slower onset of action. Often in cocaine abusers, the reduced blood supply to the nasal septum leads to the development of a perforation between the nasal passages. The effects of cocaine last approximately 40 minutes, while the effects of other stimulants usually last several hours, as each has a different half-life. 

Yes, it s possible that with the removal of drug laws a few timid Presbyterians will venture a snort of cocaine, but in the main, drug abuse will be no worse than it is now, and -after some initial experimentation- things will return to a natural balance. There is no "Middle America" sitting out there, ready to go Whoopie with the repeal of the drug laws. The majority of the population will, however, benefit from the return of the criminal justice system s attention to theft, rape, and murder, the crimes against society for which we need prisons. 

So we have a situation where people assume that because someone passes a drug test, then they must be safe. The fact is, an airline pilot can snort a line of cocaine five minutes before a drug test and pass no problem then step into the cockpit for a couple hour flight and be severely impaired. 

The methods of cocaine administration include ingestion, inhalation of the powder (snorting) or smoke, topical, and intravenous injection. The intensity and duration of action are a function of the mode of administration. I.V. injection and smoking are the fastest ways to initiate the effects. The quicker the "rush" the shorter the duration of action. Snorting results in peak plasma concentrations of 150-200 ng/mL while smoking results in >900 ng/mL. A snorter s 3-5 cm "line" of cocaine will be about 20-30 mg of material. 

Addicts use cocaine intravenously or by snorting the powder. After intravenous injections, coma and respiratory depression can occur rapidly. It has been reported that fatalities associated with snorting usually occur shortly after the abrupt onset of major motor seizures, which may develop within minutes to an hour after several nasal ingestions. Similar results occur if the substance is taken by mouth Treatment is directed toward ventilatory support and control of seizures—although in many instances a victim may not be discovered in time to prevent death. It is interesting to note that cocaine smugglers, who have placed cocaine-filled condoms in their rectum or alimentary tract, have died (Suarez et al.. 1977). The structural formula of cocaine is given in Fig 1. 

Some individuals take Rohypnol with heroin to enhance the high. This may be particularly tme for users of low-quality heroin, according to The National Clearinghouse for Alcohol and Drug Information. Users of cocaine and crack cocaine may snort crushed Rohypnol or take Rohypnol pills after using cocaine to ease some of the negative side effects. 

Cocaine is a local anesthetic with a peripheral sympathomimetic action that results from inhibition of transmitter reuptake at noradrenergic synapses (see Chapter 6 Introduction to Autonomic Pharmacology). It readily enters the central nervous system and produces an amphetamine-like effect that is shorter lasting and more intense. The major action of cocaine in the central nervous system is to inhibit dopamine reuptake into neurons in the "pleasure centers" of the brain. These properties and the fact that it can be smoked, "snorted" into the nose, or injected for rapid onset of... 

As noted above, cocaine differs from the other local anesthetics in its cardiovascular effects. Cocaine s blockade of norepinephrine reuptake results in vasoconstriction and hypertension. It may also precipitate cardiac arrhythmias. The vasoconstriction produced by cocaine can lead to ischemia and, in chronic abusers, to ulceration of the mucous membrane and even damage to the nasal septum when "snorted." This vasoconstrictor property of cocaine can be used clinically to decrease bleeding from mucosal damage in the nasopharynx. 

Adverse effects of cocaine include constricted peripheral blood vessels, dilated pupils, and increased body temperature, heart rate, and blood pressure. Cocaine induces several immediate euphoric effects, such as hyperstimulation, reduced fatigue, and mental clarity, all of which depend on the administration route. The faster the absorption of cocaine, the more severe the effects. In contrast, faster absorption limits the duration of action. For example, the effect from snorting cocaine may last 15 to 30 minutes, whereas effects from smoking may last 5 to 10 minutes. Increased use can reduce the period of stimulation, as addicted humans may develop tolerance. In rare instances, sudden death may occur on the first use of cocaine or unexpectedly thereafter. 

Upon waking, the woman reported that she had been at a friend s party earlier in the evening, where she had been drinking beer. She said she had also been to a dance club in town later in the evening. She said she spent the latter part of the evening with a group of men at the club, where she consumed about five beers. Also at the club, the woman and one male acquaintance had snorted what the woman had thought were several lines of cocaine. 

Cocaine use may account for up to 25% of acute myocardial infarctions among patients aged 18-45 years. The safety of a 12-hour observation period in a chest pain unit followed by discharge in individuals with cocaine-associated chest discomfort who are at low risk of cardiovascular events has been evaluated in 302 consecutive patients aged 18 years or older (66% men, 70% black, 84% tobacco users) who developed chest pain within 1 week of cocaine use or who tested positive for cocaine (59). Cocaine use was self-reported by 247 of the 302 subjects and rest had urine positive for cocaine 203 had used crack cocaine, 51 reported snorting, and 10 had used it intravenously. Of the 247 who reported cocaine use, 237 (96%) said they had used it in the week before presentation and 169 (68%) within 24 hours before presentation. Follow-up information was obtained for 300 subjects. There were no deaths from cardiovascular causes. Four patients had a non-fatal myocardial infarction during the 30-day period all four had continued to use cocaine. Of the 42 who were directly admitted to hospital, 20 had acute coronary syndrome. The authors suggested that in... 

Dissection of the aorta has been reported during cocaine use (82,83). The authors of these two reports noted that all six cases of this rare complication reported in the past 5 years were in men with pre-existing essential hypertension. In a review of emergency visits to a hospital during a 20-year period, 14 of 38 cases of acute aortic dissection involved cocaine use 6 were of type A and 8 of type B (84). Crack cocaine had been smoked in 13 cases and powder cocaine had been snorted in one case. The mean time of onset of chest pain was 12 hours after cocaine use. The chronicity of cocaine use was not known in most of the cases. The cocaine users were typically younger than the non-cocaine users. Chronic untreated hypertension and cigarette smoking were often present. 

Occasional snorting of powder cocaine in Social situations is probably not harmful for most people, but one should be aware that the possibility of using this drug to excess is very.real, and that excessive cocaine use can have devastating effects on one s life, it is even more difficult to limit intake of crack cocaine to levels compatible with good physical and emotional health. 

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